Living With Diabetes: Diabetes Dangers From Head to Toe Continued

Ed Geehr, M.D.: Well, you’re going to get some complications from diabetes. That is inevitable. However, the severity of the complications can be modified to a significant degree by good blood glucose control.

Ron Caporale: Right. And let’s just for a second step back and talk about two different types of diabetes. There’s type A and type B, correct? And the difference really is what?

Ed Geehr, M.D.: Well, now the nomenclature is type 1 and type 2. Type 1 – which used to be called juvenile onset diabetes, because it typically occurs in teenagers, but can occur even younger than that – is an autoimmune disorder. That’s where your immune system actually turns on your pancreas – the areas in your pancreas that produce insulin – and for some reason, attack those very cells. So you lose insulin production.

Type 2 diabetes, which we used to call adult onset diabetes – we don’t anymore because now, because of the obesity problem in America, it’s affecting younger and younger people. So type 2 is where typically it’s associated with obesity. That’s where you still maintain some insulin production, but it’s not as effective. The cells become somewhat more resistant to its effect and therefore aren’t able to get the blood glucose into the cells, and it accumulates in the body.

Ron Caporale: Now, more prone to complications, with type 1 or type 2 - what are the differences there?

Ed Geehr, M.D.: Yeah. Type 1 tends to be the worst of the two, although you can get the same complications with type 2 that you can get with type 1. It’s just that [with] type 1, typically the onset is earlier, so you have more years of exposure to high blood sugar levels, and so you tend to get worse complications.

Ron Caporale: Now, we’ve all heard the horror stories about people having feet amputated, legs amputated, that kind of thing. Why does that happen, and what’s the real risk level for that in one type versus the other?

Ed Geehr, M.D.: Yeah. So they both can lead to that complication, although type 1 is worse. As I mentioned earlier, you get two effects on the legs and feet. One is you get diminished vascular supply, so you get peripheral artery disease. And then the second thing is that your nervous system becomes impaired, and so your sensation of injury or trauma, or even a stone in your shoe, you’re not going to perceive, and it can lead to wounds. Those wounds then don’t heal very well because of the poor vascular supply. You get chronic wounds and eventually you may have to have amputations.

Ron Caporale: Now, the nerve damage that you mentioned: Can that be reversed?

Ed Geehr, M.D.: Unfortunately, the nerve damage is not reversible, but you can slow down the progression of the nerve damage through good blood glucose control.

Ron Caporale: OK, let’s talk about men versus women. Any difference in the complications that they face? Any difference in the risk factors?

Ed Geehr, M.D.: Well, there are some obvious ones - for example, women can get gestational diabetes, meaning they get diabetes during pregnancy. Most of the time that just goes away, but it is a complication, obviously, women are going to suffer that men aren’t. Women also get vaginal yeast infections that obviously aren’t going to affect men – although men can get throat yeast infections from diabetes as well. Women also tend to get more depressed with their diabetes than men. But otherwise, the profiles of the complications is relatively the same.

Ron Caporale: OK, and what’s the No. 1 thing somebody should be looking out for to try and figure out: Am I developing one of these complications with my disease?

Ed Geehr, M.D.: Well, the typical complications of, or the early warning signs of diabetes – things like thirst, hunger, fatigue and so forth - are present. But the specific ones that indicate a complication really can be very subtle. So you may notice you get some more blurriness of vision than you might ordinarily. Or you may get some chest pain from diminished vascular supply. But most of the complications unfortunately, aren’t noticed – that is, you don’t have any symptoms until much later in the disease.

Ron Caporale: So besides keeping in touch with your primary care physician, and I suppose an endocrinologist, what other specialists should somebody with diabetes see? Who else should be on the team?

Ed Geehr, M.D.: Well, for women certainly, absolutely have your gynecologist involved in the care, because it’s very important that they know you have diabetes - because they’re going to check you in a way that they might not ordinarily if you didn’t have diabetes. So they’re going to be checking for complications of diabetes – infections and so forth. In addition to the gynecologist, again, if you’re having problems of the nervous system, a neurologist can help you with those. If you’re having heart problems, a cardiologist, obviously. And then an ophthalmologist - you want to have [one] checking you on a very regular basis to see how the retina and the eyes are responding to the diabetes.

Ron Caporale: And if you suspect you have diabetes or are going to make any changes to your normal health regimen, you should check in with your doctor first.

Ed Geehr, M.D.: Absolutely. Don’t change a thing until your doctor’s on board with you on that plan.

Ron Caporale: All right. Dr. Geehr, thanks.

Ed Geehr, M.D.: Thanks.

Ron Caporale: For more information on diabetes, visit our Diabetes Health Center at www.lifescript.com, and be sure to watch our next episode here where we’ll examine diabetes myths. For now, I’m Ron Caporale in Los Angeles. Thanks for watching.

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